Initial Guardianship Plan (Report) Of Guardian Of Person (Adult)

IN THE CIRCUIT COURT FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA, GUARDIANSHIP, PROBATE AND MENTAL HEALTH DIVISION IN RE: THE GUARDIANSHIP OF CASE NO.: _____-CP-_________ ______________________________________ (Name) DIVISION: __________________ INITIAL GUARDIANSHIP PLAN (GUARDIANSHIP REPORT) OF GUARDIAN OF THE PERSON (adult) If limited guardianship, check rights which were removed: __to marry __to contract __vote __determine residency __apply for gov't benefits __choose social environment __to sue/defend __to give gifts __consent to treatment __to travel __driver's license __seek employment ________________________, the guardian of the person of _______________________ (the ward), submits the following plan as the Initial Guardianship Plan of this guardian: 1. During the period beginning ________________________, 20______ and ending ______________________, 20______, the guardian proposes the following plan for the benefit of the ward, which is based upon the recommendations of the examining committee's comprehensive examination, as incorporated into the Court's order determining incapacity. a.) Medical, mental or personal care services to be provided for the best welfare of the ward (Which doctor(s) does the ward visit regularly? What kind of assistance does the ward require for activities of daily living? Does the ward require any mental health care?): 1 American LegalNet, Inc. www.FormsWorkFlow.com b.) Social and personal service to be provided for the best welfare of the ward (The guardian must detail all services provided to or for the ward, including any services provided by friends, family, paid caregivers or facility staff.): c.) Place and kind of residential setting best suited for the needs of the ward (Please list the ward's address, name and type of facility, if applicable, and describe why this is the best, least restrictive, living arrangement for the ward): d.) Description of health and accident insurance and any other private or governmental benefits to which the ward may be entitled to meet any part of the costs of medical, mental health or related services provided to the ward (list all types of income/benefits received by or for the ward, for example, Social Security, pensions, Medicare, Medicaid, etc...): e.) Physical and mental examinations necessary to determine the ward's medical and mental health treatment needs, including names of those who will provide examinations and approximate dates for examinations (Do NOT include examining committee physicians or reports. What care providers does the guardian intend to have the ward see in the coming reporting period?): 2 American LegalNet, Inc. www.FormsWorkFlow.com 2. The guardian hereby attests that the guardian has consulted with the ward, and, to the extent reasonable, honored the ward's wishes consistent with the rights retained by the ward under the plan, and to the maximum extent reasonable, the plan is in accordance with the wishes of the ward. 3. This Initial Guardianship Plan does not restrict the physical liberty of the ward more than is reasonably necessary to protect the ward or others from serious physical injury, illness or disease and provides the ward with medical care and mental health treatment for the ward's physical and mental health. Under penalties of perjury, I declare that I have read the foregoing and the facts alleged are true, to the best of my knowledge and belief. Signed on________________________, 20____. __________________________ Attorney for Guardian Print Name: _______________ Florida Bar No. ____________ Address: __________________ __________________________ Phone Number: (___) ___-____ Email Address: ___________________________ __________________________ Guardian Print Name: _______________ Address: __________________ __________________________ Phone Number: (___) ___-____ Email Address: ___________________________ REMEMBER CERTIFICATE OF SERVICE: *On Ward, if a Limited Guardianship *Ward's Attorney (usually court-appointed) *Interested Persons/Parties 3 American LegalNet, Inc. www.FormsWorkFlow.com